Prioritization Questions

In Leadership and Management class I always get confused who should be discharged first, or who should receive care first among a set of patients. How should I prioritize care when symptoms are normal for the condition they have?

~ Submitted by Jenita

That’s the million dollar question, isn’t it? Prioritization questions are some of the most difficult questions that you’ll get in nursing school. The reason is because all of the answer choices are “correct,” meaning that it is something reasonable for the nurse to do. But your job is to decide which answer is the MOST correct. After all, you know that you would need to deal with every patient eventually…but which patient is it most important to deal with first?

First of all, always ask yourself if all of the patients are really having expected symptoms for their condition, or if there is a unexpected symptom “hidden” in one of the answer choices. In an exam question, it will be rare that all of the answer choices offer completely normal symptoms (even for the condition the patient has). However, test writers like to make it difficult to identify which patients’ symptoms are abnormal or indicate possible complications. For example, if one patient is having liquid stools, it might be tempting to skip them and go see another patient who has pain of 7/10 less than 24-hours post-surgery. But if you remember that liquid stools might be an indication of fecal impaction (an unexpected but possible complication of being on bed rest), then you would realize that the first patient is having an unexpected symptom. The higher pain ratings in the second patient, however, would be an expected symptom in someone who has had surgery in the past 24-hours. Obviously, both of those patients need to be seen and treated…but we would want to address the patient with the unexpected symptom first.

If you really do have an exam question where all of the patients’ symptoms are normal or expected based on their condition, then go back to ABC’s. Patients with conditions that affect their Airway, Breathing, and/or Circulation would be priority so that you can make sure that their status is still within reasonable limits. And if ABC’s doesn’t make sense to use in a particular question, try Maslow. If you have three stable patients with Airway diseases and no new symptoms, but one patient with confusion who keeps trying to get out of bed (and is at risk for falls…) then the confused patient would probably take priority.

Just beware of the danger of “reading into” these kinds of questions. Don’t make the mistake of thinking “well, I would just send the Nursing Assistant in to watch the confused patient until I can assess the airway patients.” That is not what the question is asking. If you find you have problems with reading into the question, try rephrasing it in this way: “If I can only see ONE of these patients today and then I ignore the others and go home, which patient would it be MOST important that I see?” Often, that will help clarify the question for you.

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